Gateholme

Updated 3 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Gateholme is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Gateholme is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 26 June 2023 and ended on 12 July 2023. We visited the service on 26 June 2013 and 3 July 2023.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 11 people who used the service and 3 relatives about their experience of the care provided. We spoke with 11 members of staff including the registered manager, and care workers. We observed staff interacting with people. We reviewed a range of records. This included 4 people’s care records and multiple medication records. We looked at 3 staff files in relation to recruitment. We reviewed a variety of records relating to the management of the service.

Updated 3 August 2023

About the service

Gateholme is a residential care home providing accommodation and personal care for up to 48 people. The service supports adult with a learning disability, autistic people, people with a mental health need and people living with dementia.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

People’s experience of using this service and what we found

Right Support

Risks associated with people’s care and support were not always assessed, monitored or managed to ensure people were safe. Most staff were aware of risks associated with people’s care; therefore, this minimised the risk. However, more guidance and documentation was required to keep people safe.

We found concerns in relation to infection prevention and control, particularly in the kitchenettes and bathroom areas. The provider took appropriate actions to ensure these concerns were resolved and mitigated in the future.

People’s medicines were predominantly managed safely, and medicines were administered as prescribed. However, we found areas which required improvement. The registered manager took immediate actions to address these concerns, however we have made a recommendation that medicine audits are reviewed and updated to ensure issues can be identified and resolved in a timely way.

Accidents and incidents were recorded and analysed to ensure risks were identified and mitigated. However, this process could be improved to include environmental factors.

There were enough staff available to support people in a timely way. The provider ensured staff were recruited safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

People told us they enjoyed living at the service and felt staff supported them well. Relatives told us they were satisfied with the care and support offered to their relatives.

Right Culture

A person centred culture was not always promoted within the service. For example, staff were not always quick to respond when people required support with personal hygiene. We also saw people’s dignity was not always promoted.

Systems in place to monitor the service were not always effective. Audits had not been instrumental in identifying or resolving concerns we identified during the inspection process. Confidential and sensitive information was not always stored in line with the Data Protection Act. Care documentation was often left in communal areas. The registered manager took action to address these concerns, however new systems and processes require embedding into practice to ensure effectiveness.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 12 June 2018).

Why we inspected

We received concerns in relation to management of risks and staff training. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement, based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Gateholme’ on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to infection prevention and control, risks associated with people’s care and management.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.